Improving melanoma treatment among older patients is a key focus for Jay S. Lee, MD, a Duke surgical oncologist working to uncover age-specific outcome data while engaging patients to better understand their treatment goals.

Lee, who sees patients at Duke Raleigh in Wake County and at Duke Hospital in Durham, is one of several Duke Health physicians offering clinical trials for new melanoma therapies.

Immunotherapy has dramatically improved the effectiveness of treatments for patients with more advanced melanoma, Lee says. These treatments can reduce the need for surgery in some cases and help oncologists reduce or halt the spread of melanoma. Early diagnosis remains a key to improved outcomes.

But the effects of immunotherapy are less well known for patients in their late 70s and beyond, Lee cautions. The lack of data hampers treatment strategies for senior patients.

“The evidence is simply not as clear for older patients,” Lee says. “We need more evidence to help us understand how older patients respond to immunotherapy.“Another factor in planning treatment is that we often have a poor and incomplete understanding of what older patients want regarding outcomes following their treatment for melanoma,” Lee says. “Many older patients may be concerned about how cancer treatment will affect their quality of life.”

Younger patients diagnosed with more advanced melanoma are usually treated with immunotherapy, Lee says. Outcomes have improved dramatically, and clinical trial data guides oncologists as they direct the immunotherapy. “We need more evidence to help us understand how older patients tolerate immunotherapy,” Lee says. Existing clinical research may include some biases, Lee suggests, because the research focused on younger patients undergoing immunotherapy. Those patients typically lack the comorbidities and more limited functional status physicians often encounter with older patients.

Lee has initiated research to help clinicians better understand the effects of immunotherapy among older patients. In addition, he and oncology colleagues monitor outcomes for patients with melanoma treated at Duke Health. “Clinical trials remain our gold standard for research, but unfortunately many trials have excluded patients past a certain age, usually 75 years old,” Lee says. “That makes it more difficult to use trial data for patients who are older. We try to extrapolate, but the truth is we enter a gray zone when we are trying to compare outcomes data.”

One key to helping older patients is to consider all treatment options and discuss alternatives with the patient and family members. Patients referred to the Duke oncology program benefit from multiple care options, Lee says.